Prevalence and pattern of prescription errors in a Nigerian kidney hospital

Objectives: To determine (i) the prevalence and pattern of prescription errors in our Centre and, (ii) appraise pharmacists’ intervention and correction of identified prescription errors.Design: A descriptive, single blinded cross-sectional study.Setting: Kidney Care Centre is a public Specialist hospital. The monthly patient load averages 60 General Outpatient cases and 17.4 in-patients.Participants: A total of 31 medical doctors (comprising of 2 Consultant Nephrologists, 15 Medical Officers, 14 House Officers), 40 nurses and 24 ward assistants participated in the study. One pharmacist runs the daily call schedule. Prescribers were blinded to the study. Prescriptions containing only galenicals were excluded.Interventions: An error detection mechanism was set up to identify and correct prescription errors. Life-threatening prescriptions were discussed with the Quality Assurance Team of the Centre who conveyed such errors to the prescriber without revealing the on-going study.Main outcome measures: Prevalence of prescription errors, pattern of prescription errors, pharmacist’s intervention.Results: A total of 2,660 (75.0%) combined prescription errors were found to have one form of error or the other; illegitimacy 1,388 (52.18%), omission 1,221(45.90%), wrong dose 51(1.92%) and no error of style was detected. Life-threatening errors were low (1.1-2.2%). Errors were found more commonly among junior doctors and nonmedical doctors. Only 56 (1.6%) of the errors were detected and corrected during the process of dispensing.Conclusion: Prescription errors related to illegitimacy and omissions were highly prevalent. There is a need to improve on patient-to-healthcare giver ratio. A medication quality assurance unit is needed in our hospitals.Funding: No financial support was received by any of the authors for this study.Keywords: Doctors, drugs, hospitals, Nigeria, prescription errors

Changes in antioxidant status associated with haemodialysis in chronic kidney disease

Oxidative stress has been implicated in the pathogenesis, progression of chronic kidney disease (CKD) and development of cardiovascular complications. Hemodialysis (HD) has also been described to contribute significantly to oxidative stress in CKD patients, though reports are conflicting.Objective: We evaluated the effects of one session of HD on the antioxidant capacity and lipid peroxidation in CKD patients.Method: Thirty-six CKD patients requiring HD were recruited into this study. Participants were naïve to HD and each completed a session of three hours using polysulfone membrane dialyzers. Blood samples were collected before and after dialysis. Total antioxidant capacity (TAC) was measured by ferric reducing antioxidant power (FRAP) while malondialdehyde (MDA) was measured using thiobarbituric acid-reactive substance (TBARS). Comparison was made between pre-HD and post-HD values of TAC and MDA respectively, p value of <0.05 was taken as significant.Result: Mean age and estimated glomerular filtration rate of subjects were 45 ±15 years and 6.3± 4.7mls/1.73m2 respectively. There was significant decrease in the mean TAC from 1232.2 ± 495.6 μmol Trolox equiv/ to 832.4 ±325.7 μmol Trolox equiv/L post-dialysis (p< 0.001) while MDA values were similar before and after HD (11.8 ± 1.8 vs 11.8 ± 2.331)μmol/L (p> 0.05). There was no significant association between changes in antioxidant status following HD with blood flow rate, ultrafiltration volume nor dialyzer per size.Conclusion: A session of HD in patients with CKD is associated with significant reduction of the total antioxidants capacity; and no effect on MDA levels.Funding: No external funding receivedKeywords: oxidative stress, antioxidants capacity, hemodialysis, chronic kidney diseas

Clinical presentation and outcome of autosomal dominant polycystic kidney disease in Nigeria

Introduction: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is presumably rare in Africa. Knowledge about the disease in Nigeria is limited as demonstrated by scanty articles on the subject. Objectives: To determine the pattern of clinical presentation and outcome of ADPKD among ADPKD patients. Method: ADPKD subjects were prospectively studied between January 1996 and December 2010. Their demographics, clinical and investigation parameters were documented. Dependency on dialysis, renal transplant and death were the final outcomes. Results: Forty one patients (M:F=1.3:1) with mean age of 48.6±4.6 years were studied. ADPKD was diagnosed at 2.73 cases per annum. Family history of ADPKD and hypertension were present in 56.1% and 82.9% respectively. Their mean systolic and diastolic blood pressures were 166.9 ±23.6 and 104 ±21.2 respectively. Nocturia (78.0%) and loin pain (68.3%) were the most common presenting symptoms. Liver cysts (31.7%) and aortic regurgitation (22.0%) were the predominant extra-renal manifestations. Twenty three (56.1%) received haemodialysis; no renal transplantation. Death rate was 51.2%. Presence of uraemia and intra-cerebral aneurysm contributed significantly to mortality. Conclusion: ADPKD may not be so rare in Nigeria. Awareness campaign to change attitude of family members to screening and further studies using newer criteria for diagnosis of ADPKD should be conducted.Keywords: Clinical presentation, autosomal dominant polycystic, kidney disease, Nigeria

Clinical presentation and outcome of autosomal dominant polycystic kidney disease in Nigeria

Introduction: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is presumably rare in Africa. Knowledge about the disease in Nigeria is limited as demonstrated by scanty articles on the subject. Objectives: To determine the pattern of clinical presentation and outcome of ADPKD among ADPKD patients. Method: ADPKD subjects were prospectively studied between January 1996 and December 2010. Their demographics, clinical and investigation parameters were documented. Dependency on dialysis, renal transplant and death were the final outcomes. Results: Forty one patients (M:F=1.3:1) with mean age of 48.6\ub14.6 years were studied. ADPKD was diagnosed at 2.73 cases per annum. Family history of ADPKD and hypertension were present in 56.1% and 82.9% respectively. Their mean systolic and diastolic blood pressures were 166.9 \ub123.6 and 104 \ub121.2 respectively. Nocturia (78.0%) and loin pain (68.3%) were the most common presenting symptoms. Liver cysts (31.7%) and aortic regurgitation (22.0%) were the predominant extra-renal manifestations. Twenty three (56.1%) received haemodialysis; no renal transplantation. Death rate was 51.2%. Presence of uraemia and intra-cerebral aneurysm contributed significantly to mortality. Conclusion: ADPKD may not be so rare in Nigeria. Awareness campaign to change attitude of family members to screening and further studies using newer criteria for diagnosis of ADPKD should be conducted

Urinary tract infections and antibiotic sensitivity pattern of uropathogens in a tertiary hospital in South West, Nigeria

Background: Urinary tract infection (UTI) is one of the factors implicated in morbidity among patients. Early diagnosis and treatment of UTI could be pivotal in overall treatment outcome. Aims: The aim of this study was to determine the prevalence of UTI, identify common isolates in UTI cases, and their in vitro sensitivity and resistance patterns to common antibiotics. Materials and Methods: This was a retrospective descriptive study of 181 patients with microbiological indications for UTI conducted between April 2014 and September 2015. Results: Out of 181 patients aged 20–86 years with a mean age of 51.43 ± 17.2 years, 79 (43.6%) had positive bacterial growth for uropathogens. Most common predisposing factors were urethral catheterization (32.5%), diabetes mellitus (23.7%), and urinary tract obstruction (18.7%). UTI was found to be more predominant among females (55.7%). The common isolates were Escherichia coli 30 (37.9%), Klebsiella pneumoniae 27 (34.2%), Pseudomonas aeruginosa 10 (12.7%), Proteus mirabilis 8 (10.1%), Enterococcus faecalis 3 (3.8%), Acinetobacter baumannii 1 (1.3%). The isolates were sensitive to nitrofurantoin and ciprofloxacin and ofloxacin while they were highly resistant to cotrimoxazole and tetracycline. Conclusions: UTI is common among patients affecting 43.6% of the participants in this study with E. coli being the most common uropathogen. ciprofloxacin, ofloxacin, and nitrofurantoin could therefore be recommended as the first line of drugs to clinicians for empirical treatment while awaiting sensitivity results. To prevent the emergence of resistant strains, rational use of drugs is encouraged